Basic Information
| Provider Information | |||||||||
| NPI: | 1548614647 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EMS | ||||||||
| FirstName: | EMMA | ||||||||
| MiddleName: | LAURA | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1630 MASON AVE STE C | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321174503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862389064 | ||||||||
| FaxNumber: | 3862389063 | ||||||||
| Practice Location | |||||||||
| Address1: | 1630 MASON AVE STE C | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862389064 | ||||||||
| FaxNumber: | 3862389063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2016 | ||||||||
| LastUpdateDate: | 10/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | ARNP9367507 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | ARNP9367507 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.